Case Presentation: A 43-year-old African-American female with a history of multiple sclerosis complicated by paraplegia, neurogenic bladder, and seizures presented to the hospital with a syncopal episode and was found to have a hemoglobin of 2.9 (12.0 to 16.0 gm/dL) with red blood cell count RBC 0.96 (4.00 – 5.20×10^6/uL), lactate dehydrogenase 639 (